Provider Demographics
NPI:1295972263
Name:MERRILL, KRISTIN SCHWELLENBACH (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:SCHWELLENBACH
Last Name:MERRILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:ANNE
Other - Last Name:SCHWELLENBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:27405 PUERTA REAL STE 330
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6358
Mailing Address - Country:US
Mailing Address - Phone:949-599-8689
Mailing Address - Fax:949-449-8280
Practice Address - Street 1:27405 PUERTA REAL STE 330
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-599-8689
Practice Address - Fax:949-599-8689
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22402103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical